An outbreak of respiratory illness first observed in the Midwest has spread to 38 states, sending children to hospitals and baffling scientists trying to understand its virulent resurgence.

As of Thursday, the Centers for Disease Control and Prevention had confirmed 226 cases of infection with enterovirus 68. But it is likely that many times that number have been stricken. One case involved an adult, and no deaths have been linked to the infection.

“What the C.D.C. is reporting is clearly the tip of the iceberg,” said Dr. Mary Anne Jackson, the division director of infectious diseases at Children’s Mercy Hospital in Kansas City, Mo. The hospital was the first to alert the agency last month to an unusual increase in children with trouble breathing. Since then, Dr. Jackson has received calls from colleagues nationwide seeking guidance. Some report that the influx of children to hospitals is “almost outweighing the resources available,” she said.

Three times in the past month, the University of Chicago Medicine Comer Children’s Hospital has had to divert ambulances to other hospitals because its emergency room was filled with children, most of them younger than 5, with severe respiratory illness. Before the outbreak, the hospital had not had to divert ambulances in 10 years, said Dr. Daniel Johnson, the interim section chief of pediatric infectious diseases at the hospital.

Enteroviruses are common, but this strain is not. Symptoms in the current outbreak resemble those of a bad cold, including body aches and cough. But some children progress to wheezing and having breathing difficulties. Scientists say they do not know why it is happening.

“Parents would love to know why this virus is causing severe disease and why there are more cases,” said Rafal Tokarz, an associate research scientist at Columbia University who has studied the virus, “but we won’t be able to answer that until a lot more research is done.”

From Aug. 18 to Sept. 24, roughly 3,600 children were treated at emergency and urgent-care facilities at Children’s Hospital Colorado. Most were sent home, but roughly 10 percent were hospitalized because they needed continuous breathing treatment, supplemental oxygen, or even to be placed on a ventilator in the intensive-care unit.

The hospital has had a “bed crunch” and is struggling to maintain supplies of albuterol, a rescue medication used by asthma sufferers, said Dr. Christine Nyquist, the director for infection prevention and control.

Experts said children should rest at home if they had run-of-the-mill cold symptoms like a runny nose, cough and body aches, but were hydrated, eating and breathing comfortably.

“If your child has mild respiratory cold symptoms, they do not need to be rushed to the E.R.,” said Dr. Marian G. Michaels, a pediatric infectious disease specialist at Children’s Hospital of Pittsburgh. The hospital’s emergency department has seen 50 to 70 more children a day for respiratory illness than is customary this time of year.

But there are signs that a child requires immediate medical care: rapid or labored breathing that involves neck muscles, wheezing, complaining of chest pain or not being able to catch one’s breath, and blue lips. A baby who has to stop drinking from a bottle to breathe should be seen by a doctor. A fever need not be present.

She said many school-aged patients told their parents, “I need to go to the E.R. because I can’t breathe.”

Children with asthma or underlying lung disease are more often sent to intensive-care units, but severe symptoms are “not limited to them,” said Dr. Meg Fisher, medical director at Unterberg Children’s Hospital at Monmouth Medical Center in Long Branch, N.J.

Dr. Fisher added: “You can’t totally say: ‘My child doesn’t have asthma. I don’t need to worry.’ ” Monitor children who have colds closely, she said, but “let’s not panic.”

She and others urged parents to take standard precautions to avoid spreading enterovirus: Wash hands often with soap and water for 20 seconds. Disinfect toys. Avoid sharing cups or utensils with sick children.

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